Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...daranisaha
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...eshaasini
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...daranisaha
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...eshaasini
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...semualkaira
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database
Original StudyType of Breast Cancer Diagnosis, Screening,a.docxvannagoforth
Original Study
Type of Breast Cancer Diagnosis, Screening,
and Survival
Carla Cedolini,1 Serena Bertozzi,1 Ambrogio P. Londero,2 Sergio Bernardi,3,4
Luca Seriau,1 Serena Concina,1 Federico Cattin,1 Andrea Risaliti1
Abstract
Organized, invitational breast cancer screening in our population succeeded in detecting early-stage tumors,
which have been consequently treated more frequently with breast and axillary conservative surgery, com-
plementary breast irradiation, and eventual hormonal therapy. The diagnosis of invasive cancer with screening
in our population resulted in a survival gain at 5 years from the diagnosis.
Introduction: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence
of breast cancers detected through screening, before and after introduction of an organized screening, and we
evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected
breast cancer or those with palpable breast cancers. Materials and Methods: We collected data about all women
who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor
diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and re-
currences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. Results: Among the 2070
cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A),
843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extra-
screening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively,
99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference
between the first 2 groups and the third (P < .05) and a trend between groups A and B (P ¼ .081). Conclusion: The
diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the
diagnosis, but a longer follow-up is necessary to confirm this data.
Clinical Breast Cancer, Vol. 14, No. 4, 235-40 ª 2014 Elsevier Inc. All rights reserved.
Keywords: Breast cancer, Breast cancer screening, Invasive breast cancer, Mammographic screening, Overall survival
Introduction
Because of the detection of early-stage tumors, breast cancer
screening reduced breast cancer mortality in Europe by 25%-31%
in patients who were invited for screening and by 38%-48% in
those who were actually screened during the last decade of the
twentieth century and the first decade of the twenty-first.1 In our
region of Italy, an organized breast cancer screening was firstly intro-
duced in 2005, but despite the high compliance of invited women
1Clinic of Surgery
2Clinic of Obstetrics and Gynecology
University of Udine, Udine, Italy
3Department of Surgery, Ospedale Civile di Latisana, Udine, Italy
4 ...
Radiation-Induced Angiosarcoma of the Breast: Retrospective Analysis at a Reg...semualkaira
Radiation-induced angiosarcoma (RIA) of the breast is an uncommon but morbid complication after radiotherapy for breast cancer. This retrospective study analysed the treatment and outcome of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England.
Radiation-Induced Angiosarcoma of the Breast: Retrospective Analysis at a Reg...semualkaira
Radiation-induced angiosarcoma (RIA) of the breast is an uncommon but morbid complication after radiotherapy for breast cancer. This retrospective study analysed the treatment and outcome of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England.
Study on Histopathological Correlation with ER, PR, and HER 2 Neu Receptor Status in Breast Carcinoma and its Prognostic Importance
Mahendra Singh, Jagdish Kumar*, Anita Omhare, Vandana Mishra, Chayanika Kala
http://dx.doi.org/10.21276/SSR-IIJLS.2019.5.1.3
Decreased Expression of P16 Indicates the Postoperative Poor Prognosis of Eso...CrimsonpublishersCancer
Expression of P16 gene that is the key regulatory protein of the cell cycle has been linked with the prognosis of Esophageal squamous cell carcinoma patients.
Evaluation of Breast Cancer in Reference to Skin ChangesQUESTJOURNAL
Introduction:- Breast cancer is the most commonly occurring female cancer in the world which is more than double that of the second ranked cancer i.e. cervical cancer. Breast cancer accounts for 23% of all cancer deaths. It is the most frequent cancer death in developing countries of the world. Mammary skin changed in breast carcinoma is categorized as advance stage in breast cancer classification. In the present study we evaluated the correlation of macroscopic, microscopic and no skin changes with axillary lymph node using histologic factor dermal lymphatic involvement. Materials and methods: prospective study was conducted on 42 breast cancer admitted patients of different age groups. Based on degree of skin involvement patients were placed into four groups, i.e. clinical stageT1 toT4. All groups were compared on the basis of percentage of patients involvement according to T1, T2, T3 and T4 stage, tumor size, histopathological dermis and epidermis involvement, dermal lymphatic invasion, tumor size and tumor subtype. Results: Majority of the patients with skin (dermis and epidermis) infiltration by the tumor (94.4%) were of T4 stage (along with dermal lymphatic invasion). Majority of the patients with only dermal lymphatic involvement (87.5%) without dermis and epidermis infiltration were of T2 stage. Conclusion: In our study, most of the patients of stage T2 and T3 with dermal lymphatic invasion had involved node when studied by routine histologic technique even though they were not clinically palpable. The identification of characteristics of the primary tumor like dermal lymphatic invasion that are associated with nodal metastases should encourage the surgeon to perform a more extensive axillary lymph node dissection and the pathologist to use methods of examining the nodes that increase the likelihood of finding metastatic disease. From this we can conclude that patients in early stage breast cancer may also have metastatic axillary lymph nodes. Dermal lymphatic invasion may be regarded as the precursor of nodal involvement, and all patients with nodal involvement can be assumed to have lymphatic invasion in the primary tumors. However the converse may not be true, not all patients with lymphatic invasion have nodal involvement.
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
Nuclear TK1 expression is an independent prognostic factor for survival in pr...Enrique Moreno Gonzalez
TK1 expression was determined by immunohistochemistry in cervical lesions (cervical intraepithelial neoplasia (CIN), n = 216; invasive cervical carcinoma, n = 84). TK1 and Ki-67
expressions and pathological/FIGO stages and age were correlated with 5-year survival by Kaplan-Meier, log rank and COX hazard uni- and multivariate analyses.
Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
Drug Repurposing: Recent Advancements, Challenges, and Future Therapeutics fo...JohnJulie1
Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
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Original StudyType of Breast Cancer Diagnosis, Screening,a.docxvannagoforth
Original Study
Type of Breast Cancer Diagnosis, Screening,
and Survival
Carla Cedolini,1 Serena Bertozzi,1 Ambrogio P. Londero,2 Sergio Bernardi,3,4
Luca Seriau,1 Serena Concina,1 Federico Cattin,1 Andrea Risaliti1
Abstract
Organized, invitational breast cancer screening in our population succeeded in detecting early-stage tumors,
which have been consequently treated more frequently with breast and axillary conservative surgery, com-
plementary breast irradiation, and eventual hormonal therapy. The diagnosis of invasive cancer with screening
in our population resulted in a survival gain at 5 years from the diagnosis.
Introduction: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence
of breast cancers detected through screening, before and after introduction of an organized screening, and we
evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected
breast cancer or those with palpable breast cancers. Materials and Methods: We collected data about all women
who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor
diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and re-
currences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. Results: Among the 2070
cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A),
843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extra-
screening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively,
99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference
between the first 2 groups and the third (P < .05) and a trend between groups A and B (P ¼ .081). Conclusion: The
diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the
diagnosis, but a longer follow-up is necessary to confirm this data.
Clinical Breast Cancer, Vol. 14, No. 4, 235-40 ª 2014 Elsevier Inc. All rights reserved.
Keywords: Breast cancer, Breast cancer screening, Invasive breast cancer, Mammographic screening, Overall survival
Introduction
Because of the detection of early-stage tumors, breast cancer
screening reduced breast cancer mortality in Europe by 25%-31%
in patients who were invited for screening and by 38%-48% in
those who were actually screened during the last decade of the
twentieth century and the first decade of the twenty-first.1 In our
region of Italy, an organized breast cancer screening was firstly intro-
duced in 2005, but despite the high compliance of invited women
1Clinic of Surgery
2Clinic of Obstetrics and Gynecology
University of Udine, Udine, Italy
3Department of Surgery, Ospedale Civile di Latisana, Udine, Italy
4 ...
Radiation-Induced Angiosarcoma of the Breast: Retrospective Analysis at a Reg...semualkaira
Radiation-induced angiosarcoma (RIA) of the breast is an uncommon but morbid complication after radiotherapy for breast cancer. This retrospective study analysed the treatment and outcome of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England.
Radiation-Induced Angiosarcoma of the Breast: Retrospective Analysis at a Reg...semualkaira
Radiation-induced angiosarcoma (RIA) of the breast is an uncommon but morbid complication after radiotherapy for breast cancer. This retrospective study analysed the treatment and outcome of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England.
Study on Histopathological Correlation with ER, PR, and HER 2 Neu Receptor Status in Breast Carcinoma and its Prognostic Importance
Mahendra Singh, Jagdish Kumar*, Anita Omhare, Vandana Mishra, Chayanika Kala
http://dx.doi.org/10.21276/SSR-IIJLS.2019.5.1.3
Decreased Expression of P16 Indicates the Postoperative Poor Prognosis of Eso...CrimsonpublishersCancer
Expression of P16 gene that is the key regulatory protein of the cell cycle has been linked with the prognosis of Esophageal squamous cell carcinoma patients.
Evaluation of Breast Cancer in Reference to Skin ChangesQUESTJOURNAL
Introduction:- Breast cancer is the most commonly occurring female cancer in the world which is more than double that of the second ranked cancer i.e. cervical cancer. Breast cancer accounts for 23% of all cancer deaths. It is the most frequent cancer death in developing countries of the world. Mammary skin changed in breast carcinoma is categorized as advance stage in breast cancer classification. In the present study we evaluated the correlation of macroscopic, microscopic and no skin changes with axillary lymph node using histologic factor dermal lymphatic involvement. Materials and methods: prospective study was conducted on 42 breast cancer admitted patients of different age groups. Based on degree of skin involvement patients were placed into four groups, i.e. clinical stageT1 toT4. All groups were compared on the basis of percentage of patients involvement according to T1, T2, T3 and T4 stage, tumor size, histopathological dermis and epidermis involvement, dermal lymphatic invasion, tumor size and tumor subtype. Results: Majority of the patients with skin (dermis and epidermis) infiltration by the tumor (94.4%) were of T4 stage (along with dermal lymphatic invasion). Majority of the patients with only dermal lymphatic involvement (87.5%) without dermis and epidermis infiltration were of T2 stage. Conclusion: In our study, most of the patients of stage T2 and T3 with dermal lymphatic invasion had involved node when studied by routine histologic technique even though they were not clinically palpable. The identification of characteristics of the primary tumor like dermal lymphatic invasion that are associated with nodal metastases should encourage the surgeon to perform a more extensive axillary lymph node dissection and the pathologist to use methods of examining the nodes that increase the likelihood of finding metastatic disease. From this we can conclude that patients in early stage breast cancer may also have metastatic axillary lymph nodes. Dermal lymphatic invasion may be regarded as the precursor of nodal involvement, and all patients with nodal involvement can be assumed to have lymphatic invasion in the primary tumors. However the converse may not be true, not all patients with lymphatic invasion have nodal involvement.
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
Nuclear TK1 expression is an independent prognostic factor for survival in pr...Enrique Moreno Gonzalez
TK1 expression was determined by immunohistochemistry in cervical lesions (cervical intraepithelial neoplasia (CIN), n = 216; invasive cervical carcinoma, n = 84). TK1 and Ki-67
expressions and pathological/FIGO stages and age were correlated with 5-year survival by Kaplan-Meier, log rank and COX hazard uni- and multivariate analyses.
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Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
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Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
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Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
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Skeletal muscle channelopathy are rare heterogeneous episodic disorders with marked genotypic and phenotypic variability resulting in periodic paralysis, and falls in young people which often misdiagnosed or undiagnosed due to its rarity, often the symptoms are miscommunicated to the treating phycision due to its episodic nature and not uncommonly physical examination by the time patient attend the clinic or hospital will be unremarkable apart from periodic muscle paralysis where patient will presented to ED with flaccid weakness,
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. clinicsofoncology.com 2
Volume 6 Issue 6 -2022 Research Article
invasive ductal carcinoma (IDC). Previous studies demonstrated
that there was no difference in the prognosis of IMPC and IDC [7-
11]. In contrast, another study found that IMPC had a better prog-
nosis than IDC despite its highly aggressive clinical presentation
[12]. In a recent meta-analysis, IMPC exhibited a similar, even
favorable, overall survival rate but a shorter relapse-free survival
rate than IDC [13]. There was no consensus on IMPC prognosis
and treatment worldwide to date. In this retrospective study, we
analyzed the survival rate of IMPC and IDC by using the Surveil-
lance, Epidemiology, and End Results (SEER) database.
3. Materials and Methods
3.1. Data source and Patient Selection
Data were retrieved from the National Cancer Institute’s Surveil-
lance, Epidemiology, and End Results (SEER) 18 registry data-
base released in April 2019 by the v8.3.8 SEER*Stat program.
The ICD-O-3 (International Classification of Diseases for Oncol-
ogy Version 3) codes of IMPC and IDC were 8507 and 8500/3,
respectively. Since HER2 (human epidermal growth receptor 2)
status records were available after 2010 in the SEER database, we
chose IMPC and IDC patients diagnosed between 1 January 2010
and 31 December 2016. Search criteria were restricted to patients
who were female, had confirmed histology of invasive carcino-
ma and whose tumor was a primary occurrence. Exclusion crite-
ria including bilateral breast cancer, autopsy or death certification
reports, unknown American Joint Committee on Cancer (AJCC)
TNM stage (7th edition), unknown estrogen receptor (ER)/proges-
terone receptor (PR)/HER2 status, unknown pathological grade or
surgery type and stage IV disease.
3.2. Propensity Score Matching
To avoid bias and balance the basic characteristics for the analysis,
we performed 1:1 propensity score matching (PSM). PSM vari-
ables were selected as follows: age, histologic grade, T stage, N
stage, ER, PR, and HER2 status.
3.3. Statistical Analysis
The primary outcomes were the breast cancer-specific survival
(BCSS) and overall survival (OS) rates. The BCSS rate was de-
fined as the time from disease occurrence to the date of death due
to breast cancer and the OS rate was defined as the time from dis-
ease occurrence to the date of death due to any cause.
Univariate and multivariate Cox proportional hazards models were
generated to assess the unadjusted and adjusted odds ratios (ORs)
with 95% CIs (confidence intervals) of the various characteristics
of IMPC patients. To confirm the difference in regional node me-
tastasis, Mann-Whitney tests were conducted for positive lymph
nodes depending on T stage. All analyses were performed via
SPSS statistical software, version 25.0 (Armonk, NY, IBM Crop).
A two-sided p < 0.05 was considered to indicate statistical signif-
icance.
4. Results
4.1. Characteristics of IMPC and IDC
Based on the inclusion and exclusion criteria, 921 patients with
IMPC and 173,621 patients with IDC were included (Figure 1).
Compared to the IDC, the IMPC had more advanced stage and
more nodal metastasis (stage III: 22.37% vs. 11.26%, T3/T4 stage:
11.40% vs. 7.37%, nodal metastasis: 48.97% vs. 31.41%). As
for nodal metastasis, IMPC metastasized more than IDC at any
T stage (p<0.05) (Figure 2). In terms of subtype, the IMPC had
a higher proportion of ER-positive (91.21% vs. 80.77%, p<0.01)
and PR-positive (81.76% vs. 70.97%, p<0.01), and the triple-neg-
ative subtype accounted for only 4.0% of IMPC patients. In addi-
tion, a higher percentage of IMPC patients received chemotherapy
(52.55% vs. 44.87%, p<0.01) and radiation therapy (61.13% vs.
55.12%, p<0.01). The types of surgery distributed similarly be-
tween the two histological types (p=0.13).Acomplete 1:1 matched
case-control study by the propensity score match (PSM) method
was performed. A total of 917 IMPC patients were completely
matched to another 917 IDC patients (Table 1). In PSM cohort,
compared to IDC, IMPC group were treated with similar type of
surgery (p=0.68), chemotherapy (p=0.58) and radiation (p=0.10).
Figure 1: Flow chart of selecting records of patients with SEER database.
4. clinicsofoncology.com 4
Volume 6 Issue 6 -2022 Research Article
BCS 104,465 (59.93%) 103,932 (59.94%) 533 (57.87%) 1,082 (59.00%) 549 (59.87%) 533 (58.12%)
Mastectomy 63,221 (36.27%) 62,861 (36.25%) 360 (39.09%) 694 (37.84%) 338 (36.86%) 356 (38.82%)
Chemotherapy <0.01 0.58
None/
Unknown
96,035 (55.09%) 95,598 (55.13%) 437 (47.45%) 884 (48.20%) 448 (48.85%) 436 (47.55%)
Yes 78,282 (44.91%) 77,798 (44.87%) 484 (52.55%) 950 (51.80%) 469 (51.15%) 481 (52.45%)
Radiation
therapy
<0.01 0.1
None/Unknown 78,171 (44.84%) 77,813 (44.88%) 358 (38.87%) 680 (37.08%) 323 (35.22%) 357 (38.93%)
Yes 96,146 (55.16%) 95,583 (55.12%) 563 (61.13%) 1,154 (62.92%) 594 (64.78%) 560 (61.07%)
4.2. Overall Survival and Breast Cancer-Specific Survival
The median length of follow-up was 40 months for the IDC group
and 32 months for the IMPC group. Overall, patients with IMPC
had better survival outcomes than IDC patients as revealed by
both the BCSS (HR=0.57, 95% CI: 0.41-0.78, p<0.01) and OS
(HR=0.74, 95% CI: 0.58-0.94,p=0.03). However, after PSM, pa-
tients with IMPC and IDC had similar BCSS (HR=0.88, 95% CI:
0.54-1.45, p=0.62) and OS (HR=0.86, 95% CI: 0.62-1.20, p=0.45)
rates (Figure 3). In the long-term survival comparison with the
PSM group, IMPC patients had better OS rates from the 3rd to 5th
years and better BCSS rates at the 4th and 5th years after diagno-
sis(p<0.05). Further stratification analysis showed a better 5-year
BCSS (HR=0.36, 95%CI: 0.18-0.72, p<0.01) and OS (HR=0.35,
95%CI: 0.22-0.55, p<0.01) rate in the HR+/HER2- subtype (Ta-
ble 2). We conducted both univariate and multiple Cox regression
models for the PSM cohort (Table 3). In the univariate model,
IMPC was not an independent factor for either OS (p=0.36) or
BCSS (p=0.62), which was confirmed in the multivariate model
(OS p=0.24, BCSS p=0.41).
Figure 3: Kaplan-Meier survival curves of the OS and BCSS rates of the whole/PSM cohort. (a-b. OS and BCSS rate of whole cohort. b-c. OS and
BCSS rate of PSM cohort.).
Table 2: Long-term survival comparison and subtype subset analysis of IMPC and IDC in the PSM group
BCSS OS
Survival rates HR(95% CI) p Survival rates HR(95% CI) p
IMPC IDC IMPC IDC
Year of survival
1 year survival 99.5 99.9 5.02(0.59-43.07) 0.1 98.4 98.7 1.25(0.58-2.69) 0.56
2 year survival 96.9 97.1 1.04(0.61-1.78) 0.89 96.9 97.1 1.04(0.61-1.78) 0.89
3 year survival 98.3 97.1 0.59(0.31-1.09) 0.09 96.2 93.9 0.61(0.40-0.94) 0.02
4 year survival 98 96.2 0.51(0.28-0.90) 0.02 95.6 91.7 0.51(0.34-0.75) <0.01
5 year survival 97.9 95.5 0.45(0.26-0.79) <0.01 95.1 90.2 0.47(0.33-0.69) <0.01
1 year survival correlation
HR+/HER2- 99.6 99.9 3.01(0.31-29.0) 0.32 98.8 98.5 1.25(0.58-2.69) 0.64
HR+/HER2+ 100 100 1.00(1.00-1.00) >0.99 98.1 98.8 0.80(0.31-2.03) 0.65
HR-/HER2+ 97.5 100 1.03(0.98-1.08) 0.31 95,0 100 1.51(0.25-9.16) 0.15
Triple negative 97.3 100 1.03(0.97-1.08) 0.31 94.6 100 1.06(0.98-1.14) 0.15
5. clinicsofoncology.com 5
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3 year survival correlation
HR+/HER2- 98.5 97.1 0.49(0.23-1.06) 0.07 96.9 93.4 0.45(0.27-0.76) <0.01
HR+/HER2+ 98.8 98.8 1.00(0.14-7.19) >0.99 95.6 96.9 1.42(0.44-4.57) 0.56
HR-/HER2+ 97.5 97.5 1.00(0.06-16.56) >0.99 95 97.5 2.05(0.18-23.59) 0.56
Triple negative 91.9 89.2 0.73(0.15-3.51) 0.69 86.5 86.5 1.00(0.26-3.79) >0.99
5 year survival correlation
HR+/HER2- 98.4 95.6 0.36(0.18-0.72) <0.01 96.2 89.7 0.35(0.22-0.55) <0.01
HR+/HER2+ 98.8 98.1 0.66(0.11-4.02) 0.65 94.4 95 1.13(0.43-3.01) 0.8
HR-/HER2+ 97.5 97.5 1.00(0.06-16.56) >0.99 92.5 92.5 1.00(0.19-5.28) >0.99
Triple negative 86.5 81.1 0.67(0.19-2.34) 0.53 81.1 75.7 0.73(0.24-2.21) 0.57
Table 3: Univariate and multivariate Cox proportional hazard models of overall survival (OS) and breast cancer-specific survival (BCSS) rates in the
propensity score matched analysis
Univariate Multivariate
BCSS OS BCSS OS
HR(95% CI) p HR(95% CI) p HR(95% CI) p HR(95% CI) p
Pathological type
IMPC vs.
IDC
0.88(0.52-1.47) 0.62 0.85(0.60-1.21) 0.36 0.81(0.48-1.35) 0.41 0.81(0.57-1.15) 0.24
Age
>50 vs. ≤50 1.48(0.81-2.70) 0.12 3.18(1.87-5.41) <0.01 2.51(1.32-4.79) 0.01 3.52(2.02-6.13) <0.01
Stage
I & II vs. III 6.28(3.9-10.10) <0.01 2.69(1.95-3.71) <0.01 7.37(4.17-13.01) <0.01 2.34(1.86-2.94) <0.01
Grade
I & II vs. III 2.37(1.49-3.79) <0.01 1.43(1.04-1.95) 0.03 2.09(1.26-3.44) <0.01 1.45(1.09-1.94) 0.02
Subtype
HR+/HER2- ref. 0.01 ref. <0.01 ref. <0.01 ref. <0.01
HR+/HER2+ 0.47(0.19-1.18) 0.70(0.42-1.16) 0.16 0.32(0.12-0.8) 0.02 0.70(0.41-1.18) 0.18
HR-/HER2+ 1.05(0.33-3.37) 1.22(0.60-2.50) 0.58 1.03(0.32-3.37) 0.96 1.71(0.82-3.58) 0.16
HR-/HER2- 4.72(2.52-8.86) 2.90(1.74-4.83) <0.01 3.73(1.89-7.34) <0.01 3.14(1.83-5.40) <0.01
Surgery
Mast. vs.
BCS
2.77(1.30-5.90) 0.03 3.26(1.89-5.60) <0.01 1.50(0.67-3.33) 0.32 0.59(0.32-1.11) 0.1
Chemotherapy
Yes vs. No 1.71(1.05-2.78) <0.01 0.65(0.47-0.89) 0.01 0.98(0.56-1.71) 0.93 0.48(0.33-0.70) <0.01
Radiation therapy
Yes vs. No 0.37(0.23-0.59) <0.01 0.34(0.25-0.47) <0.01 0.33(0.2-0.57) <0.01 0.32(0.22-0.46) <0.01
*Mast.= mastectomy
4.3. HR+/HER2- Invasive Micropapillary Carcinoma Had
Better Long-Term Survival Outcomes
91.5% of the IMPC and 82% of the IDC were luminal type (HR+,
Her2-/+) (p<0.01, Mann-Whitney U-test) respectively. Therefore,
it is necessary to confirm weather higher propotions of luminal
subtype influence IMPC prognosis. In the PSM cohort, we per-
formed a subgroup analysis based on breast subtype. The OS rate
of IMPC was significantly better than that of IDC for the HR+/
HER2- type (HR=0.65, 95% CI: 0.44-0.98, p=0.04) but the BCSS
rate was similar (HR=1.31, 95% CI: 0.68-2.52, p=0.19). (Figure
4) In the HR+/HER2- subtype, IMPC and IDC patients received
similar treatments, including surgery (p=0.27), chemotherapy
(p=0.99), and radiotherapy (p=0.28) (Mann-Whitney U-test). Uni-
variate and multivariate Cox regression models were performed in
the HR+/HER2- subset, and IMPC was an independent prognostic
factor for OS (Table 4).
Table 4: Univariate and multivariate Cox proportional hazard models of overall survival (OS) and breast cancer-specific survival (BCSS) rates in the
HR+/HER2- subset in the propensity score matched analysis.
Univariate Multivariate
BCSS OS BCSS OS
HR(95% CI) p HR(95% CI) p HR(95% CI) p HR(95% CI) p
Pathological type
IMPC vs.
IDC
0.68(0.35-1.29) 0.24 0.63(0.41-0.97) 0.04 0.59(0.31-1.12) 0.1 0.58(0.38-0.90) 0.01
Age
>50 vs. ≤50 1.15(0.58-2.30) 0.69 2.72(1.46-5.05) <0.01 1.90(0.90-4.01) 0.09 2.83(1.47-5.43) <0.01
Stage
I & II vs. III 6.43(3.68-11.21) <0.01 2.53(1.72-3.71) <0.01 5.42(2.82-10.45) <0.01 3.47(2.20-5.48) <0.01
Grade
I & II vs. III 2.86(1.65-4.96) <0.01 1.60(1.10-2.32) 0.01 2.54(1.43-4.49) <0.01 1.74(1.19-2.55) 0.01
Surgery
Mast vs. BCS 4.59(2.08-10.11) <0.01 3.99(2.17-7.36) <0.01 2.91(1.26-6.74) 0.01 2.32(1.24-4.37) 0.01
Chemotherapy
Yes vs. No 2.00(1.14-3.50) 0.02 0.73(0.50-1.06) 0.1 1.24(0.64-2.40) 0.53 0.62(0.40-0.97) 0.04
Radiation therapy
Yes vs. No 0.34(0.20-0.59) <0.01 0.33(0.23-0.47) <0.01 0.34(0.18-0.64) <0.01 0.32(0.21-0.49) <0.01
6. clinicsofoncology.com 6
Volume 6 Issue 6 -2022 Research Article
Figure 4: Kaplan-Meier survival curves of the OS and BCSS rates of HR+/HER2- in the PSM cohort.
5. Discussion
Our data were collected from the latest SEER database (Novem-
ber 2019 submission). In this large, population-based cohort, we
included more patients than a previous study and incorporated re-
cords of HER2 status entered after 2010. Over 49% of patients
with IMPC had axillary lymph node involvement, while only
31% of IDC patients had regional metastasis. We observed that
IMPC had a better survival than IDC in OS and BCSS in whole
cohort, but not significant in PSM cohort, even IMPC had more
axillary lymph node metastasis. Furthermore, IMPC metastasized
more than IDC at any T stage (p<0.05). In the whole cohort, IMPC
was associated with a better outcome than IDC, but similar af-
ter PSM; however, IMPC patients had better survival outcomes
at 4 and 5 years after diagnosis (p<0.05). Additional univariate
and multivariate Cox regression models revealed that IMPC was
not an independent factor for prognosis (p>0.05). Stratification
analysis indicated a better OS outcome of HR+/HER2- subtype
IMPC (HR=0.65, p=0.04). In addition, a comparison of the distant
metastasis rate was performed, and we found IMPC had less M1
patients than IDC after PSM (p=0.01) but similar in whole cohort
(p=0.22). In stratified analysis, only HR+/HER2- subtype IMPC
metastasized less than IDC in distant location (Supplement Table
1). IMPC patients exhibited more lymph node metastasis than IDC
patients but similar survival outcomes to IDC patients, which was
similar to the previous studies [7,8,11]. However, IMPC patients
had a better survival tendency, especially at 4 and 5 years after di-
agnosis. The prognosis of IMPC remains controversial. Chen and
Fan et al. (2008) reported that IMPC is a more aggressive tumor
with a poorer prognosis [14]. Ga Young Yoon et al. (2019) dis-
covered worse recurrence-free survival (RFS) rates for IMPC than
IDC [15]. However, Chen and Paulino et al. (2014) discovered that
IMPC had better DSS and OS rates than IDC [16]. Chen and Wu et
al. (2017) found that IMPC and IDC patients had comparable OS
and BCSS rates before and after propensity score matching [17].
In addition, Hao et al. (2018) found no differences in OS and DFS
rates between IMPC and IDC patients [18]. Some of the above
studies applied propensity score matching to the whole cohort;
however, few achieved a good balance of the basic characteristics,
which might have affected the outcome of the comparison. Our
study included 173,396 IDC and 921 IMPC patients and achieved
perfect matches for age, AJCC stage, grade, and HR HER2 status
after PSM. Although no differences were observed in treatment
(p>0.05), IMPC patients tended to have better outcomes. We per-
sumed that advanced therapy might be applied causing a better
outcome. In the PSM cohort, IMPC patients received higher rates
of radiation therapy and mastectomy surgery, which could influ-
ence the long-term survival rate. Unlike the findings reported in
other studies, we unexpectedly observed that HR+/HER2- IMPC
patients had a better long-term survival rates than IDC patients.
A previous study indicated that the prevalence of the HR+ type is
high in IMPC [19] and that the TNBC subtype is associated with
worse prognosis[20]. In our research, 91.5% of IMPC patients
were HR+/HER2- type which had the best prognosis among all
breast cancer subtypes. Combined with the finding that the HR+/
HER2- type was associated with favorable OS rates in the PSM
cohort, we could assume that IMPC had a better prognosis due to
a higher proportion of the HR+/HER2- subtype. The IMPC distant
metastasis rate was similar to that of IDC in whole cohort, but less
in PSM cohort. Deman F et al. found a low rate of distant recur-
rences of stage I-III IMPCs treated with primary surgery, despite
a high proportion of grade 3 tumors and lymph node involvement
[21], but the study only included 105 IMPC patients. Tang et al.
found that IMPC had a higher rate of distant metastasis [22], but
this study included more triple-negative subtypes of IMPC (IMP-
C:IDC 21.8% vs 1.4%, p<0.01), while TNBC metastasized more
than other subtypes. Kaya C et al. discovered that between two
groups divided by IMPC component ratio (≤75% and >75%), no
differences in distant metastasis were found [23]. We propose that
despite its aggressive lymph invasion ability, IMPC lacked traits
for distant metastasis, and the mechanism within still needs to be
studied. There were some flaws within our study. We collected data
from over 921 IMPC patients from the SEER database, but a series
of clinical characteristics were absent, such as chemotherapy reg-
imens, hormone therapy, target treatment, menopausal status, etc.
Therefore, selection bias is inevitable.
7. clinicsofoncology.com 7
Volume 6 Issue 6 -2022 Research Article
Supplement Table 1: Comparison of distant metastasis rate
Whole cohort PSM cohort
All M0 M1 p All M0 M1 p
Overall 0.22 0.01
IDC 180,955 173,643(95.96%) 7,312(4.041 953 900(94.44%) 53(5.56%)
IMPC 953 922(96.75%) 31(3.25%) 953 922(96.75%) 31(3.25%)
HR+/HER2- 0.53 0.04
IDC 125,952
122,000
(70.26%)
3,952 (54.05%) 699 665 (73.89%) 34 (64.15%)
IMPC 699 680 (73.75%) 19 (61.29%) 699 680 (73.75%) 19 (61.29%)
HR+/HER2+ 0.22 0.05
IDC 21,746 20,349 (11.72%) 1,397 (19.11%) 171 155 (17.22%) 16 (30.19%)
IMPC 171 164 (17.79%) 7 (22.58%) 171 164 (17.79%) 7 (22.58%)
HR-/HER2+ 0.41 >0.99
IDC 9,666 8,886 (5.12%) 780 (10.67%) 43 41 (4.56%) 2 (3.77%)
IMPC 43 41 (4.45%) 2 (6.45%) 43 41 (4.45%) 2 (6.45%)
HR-/HER2- 0.47 0.31
IDC 23,591 22,408 (12.90%) 1,183 (16.18%) 40 39 (4.33%) 1 (1.89%)
IMPC 40 37 (4.01%) 3 (9.68%) 40 37 (4.01%) 3 (9.68%)
6. Conclusion
In summary, IMPC metastasized to more axillary lymph nodes
than IDC but the distant metastasis rate was similar. Despite ag-
gressive regional invasion, IMPC had a similar overall survival
and breast cancer specific survival outcome to IDC. However,
HR+/HER2- IMPC had a better overall survival rate than IDC.
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